Do Open Tibial Shaft Fractures Portend a Worse Outcome in the Pediatric Population? A Pilot Study Utilizing a Matched Cohort.

BACKGROUND

Tibia fractures are the third most common pediatric long bone fractures and are associated with numerous complications such as compartment syndrome, angular deformity, and nonunion. This study sought to determine if complication rates were higher in open tibia fractures than in closed tibia fractures in the pediatric population, with the hypothesis that there would be no difference.

METHODS

A single-center, retrospective cohort study was performed at a quaternary care academic pediatric hospital identifying all open tibia fractures treated from March 1, 2016, to November 30, 2021. These patients were matched by sex, age, and injury pattern, with patients treated for closed tibia fractures during this same time period. Data collected included demographics, clinical and radiographic information, and complications.

RESULTS

Both fracture groups included 30 patients (24 males and 6 females). The average age at injury was 11.3 years in the open group, and 11.2 years in the closed group. The median follow-up duration was 7.7 months (1.2-67.8 months) and 9.3 months (1.4-62.9 months) for the open and closed groups, respectively, (P = .5749). One hundred percent of open fractures were treated operatively, versus 50% of the closed-group ones (P < .0001). There was no significant difference in any type of complications when comparing the open group to the closed tibia fracture group (odds ratio: 1.29, 95% confidence interval: 0.48 to 3.45, P = .6180). The most common complication was the development of a clinically significant angular deformity (26.7% in the open group and 10% in the closed group, P = .1806). There was a 10% rate of compartment syndrome in both groups and a nonunion rate of 6.7% for the open group and 3.3% for the closed group (P > .999).

CONCLUSIONS

This pilot study utilizing a matched cohort found no significant difference in complication rates between open and closed pediatric tibia fractures, though complications were prevalent in both groups. These findings emphasize the importance of maintaining a high clinical suspicion for compartment syndrome and thoroughly counseling patients on the risks of angular deformity.

KEY CONCEPTS: (1) A matched cohort study demonstrates complication rates are similarly high in both open and closed pediatric tibial shaft fractures.(2) Angular deformity is the most common complication overall.(3) Treatment algorithms may differ in open versus closed tibial shaft fractures, with open fractures fixated with different constructs and immobilized for longer.

LEVEL OF EVIDENCE: Level III, case control study.